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Can Perioperative Interventions During Cancer Surgery Affect Recurrence or Metastasis?

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Perioperative Medicine – Current Controversies

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Abstract

Cancer continues to be a key cause of morbidity and mortality worldwide and its overall incidence continues to increase. Anaesthetists are increasingly faced with the challenge of managing cancer patients, either for surgical resection to debulk or excise the primary tumour, surgical emergencies in patients on chemotherapy, or for the analgesic management of acute or chronic pain. Metastatic recurrence is usually the cause of death in cancer patients. There is some experimental data suggesting that surgery, some general anaesthetics, acute postoperative pain and opioid analgesics may accelerate tumour growth and potentially increase the risk of metastatic recurrence. It has been hypothesized that awareness of perioperative factors promoting metastasis could enable designing anaesthetic and analgesic techniques that might attenuate these factors and reduce recurrence or metastasis. Evaluation of emerging literature indicates a signal from cell culture models of cancer cell growth supporting aspects of this hypothesis. Retrospective clinical studies of the association between various anaesthetic techniques, including regional anaesthesia, have yielded conflicting results. Currently, the most compelling evidence is for a direct effect of amide local anaesthetics on cancer cell metastatic potential, inhibiting migration by both a sodium channel and intracellular signaling mechanisms. Only prospective, randomized, clinical trials can prove a cause-and-effect link between anaesthetic technique and cancer. Although a number are ongoing, they are necessitate prolonged patient follow-up and large patient numbers, but their results will inform best practice in the perioperative care of cancer patients.

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Authors and Affiliations

  1. Department of Anaesthesia, Mater University Hospital, School of Medicine & Medical Science, University College Dublin, Dublin, Ireland

    Dalia Abdelrahman MRCSI, EDRA, FCAI & Donal J. Buggy MD, MSc, DME, FRCPI, FCAI, FRCA

  2. Outcomes Research, Cleveland Clinic, Ohio, USA

    Dalia Abdelrahman MRCSI, EDRA, FCAI & Donal J. Buggy MD, MSc, DME, FRCPI, FCAI, FRCA

Authors
  1. Dalia Abdelrahman MRCSI, EDRA, FCAI
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  2. Donal J. Buggy MD, MSc, DME, FRCPI, FCAI, FRCA
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Correspondence to Donal J. Buggy MD, MSc, DME, FRCPI, FCAI, FRCA .

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Editors and Affiliations

  1. Waimairi Anaesthesia Ltd, Christchurch, New Zealand

    Karen Stuart-Smith

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Abdelrahman, D., Buggy, D.J. (2016). Can Perioperative Interventions During Cancer Surgery Affect Recurrence or Metastasis?. In: Stuart-Smith, K. (eds) Perioperative Medicine – Current Controversies. Springer, Cham. https://doi.org/10.1007/978-3-319-28821-5_14

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  • DOI: https://doi.org/10.1007/978-3-319-28821-5_14

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